Ombrellaro M P, Stevens S L, Kerstetter K, Freeman M B, Goldman M H
Department of Surgery, University of Tennessee Medical Center, Knoxville 37920, USA.
Surgery. 1996 Jul;120(1):60-70. doi: 10.1016/s0039-6060(96)80242-x.
The purpose of this study was to investigate the effect of complete intraluminal placement on prosthetic graft healing.
Thirty dogs underwent infrarenal abdominal aorta polytetrafluoroethylene interposition (12) or intraluminal stented (18) grafting. Grafts were removed at 4 and 8 weeks. Length of endothelial ingrowth and intima to media height ratios (IMHRs) were calculated. Perianastomotic endothelial (CD31+, factor VIII [FVIII+]), smooth muscle (actin+), macrophage (CD44+), and proliferating (PCNA+) cell content was determined.
In control grafts mean proximal and distal anastomotic endothelial cell ingrowth was 0.42 +/- 0.06 and 0.47 +/- 0.08 cm at 4 weeks and 1.10 +/- 0.24 and 0.94 +/- 0.17 cm at 8 weeks. In intraluminal grafts mean proximal and distal anastomotic endothelial cell ingrowth was 1.57 +/- 0.09 and 1.54 +/- 0.12 cm at 4 weeks and 1.88 +/- 0.06 and 2.11 +/- 0.25 cm at 8 weeks. Endothelial ingrowth was greater in all stented grafts (p < 0.001). Mean proximal anastomosis IMHRs were 1.01 +/- 0.16 for 4-week and 1.42 +/- 0.16 for 8-week control grafts and 0.59 +/- 0.18 for 4-week and 0.50 +/- 0.14 for 8-week stented grafts. Similar IMHR values were present at the distal anastomosis. Lower IMHRs were observed in stented grafts (p < 0.05). Content of CD44+, PCNA+, and FVIII+ cells were reduced both proximally and distally in 4-week stented grafts (p < 0.05). Distal content of CD31+ and actin+ cells was greater in 4-week stented grafts (p < 0.05). At 8 weeks CD44+ cell content decreased in controls (p < 0.05).
Intraluminal location enhances prosthetic graft reendothelialization and attenuates intimal thickening.
本研究的目的是调查完全腔内放置对人工血管愈合的影响。
30只犬接受肾下腹主动脉聚四氟乙烯血管置换术（12只）或腔内带支架血管移植术（18只）。在4周和8周时取出移植物。计算内皮细胞向内生长的长度和内膜与中膜高度比（IMHRs）。测定吻合口周围内皮细胞（CD31+、因子VIII [FVIII+]）、平滑肌细胞（肌动蛋白+）、巨噬细胞（CD44+）和增殖细胞（PCNA+）的含量。
在对照移植物中，4周时近端和远端吻合口处内皮细胞向内生长的平均长度分别为0.42±0.06和0.47±0.08 cm，8周时分别为1.10±0.24和0.94±0.17 cm。在腔内移植物中，4周时近端和远端吻合口处内皮细胞向内生长的平均长度分别为1.57±0.09和1.54±0.12 cm，8周时分别为1.88±0.06和2.11±0.25 cm。所有带支架移植物的内皮细胞向内生长均更明显（p<0.001）。4周对照移植物近端吻合口的平均IMHRs为1.01±0.16，8周时为1.42±0.16；4周带支架移植物的平均IMHRs为0.59±0.18，8周时为0.50±0.14。远端吻合口处的IMHR值相似。带支架移植物的IMHRs较低（p<0.05）。4周带支架移植物近端和远端的CD44+、PCNA+和FVIII+细胞含量均降低（p<0.05）。4周带支架移植物远端的CD31+和肌动蛋白+细胞含量更高（p<0.05）。8周时，对照移植物中CD44+细胞含量降低（p<0.05）。
腔内放置可促进人工血管再内皮化并减轻内膜增厚。
